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Inspection Summary


Overall summary & rating

Good

Updated 10 June 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Goldington Avenue Surgery on 28 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for each of the six population groups we looked at.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • All feedback from patients was positive saying they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice scored highest in the local CCG area in the National Patient Survey and was ranked in the top 5% nationally.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management.
  • End of Life care was very good with learning shared within the locality to influence care at other practices.

However there was an area of practice where the provider needs to make improvements.

The provider should:

  • Complete an infection control audit for the entire premises and implement actions identified in previous audits.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 June 2015

The practice is rated as good for providing safe services. Staff understood their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. There were enough staff to keep patients safe. Reception staff were trained to carry out chaperone duties. A recent infection control audit had not been completed for the whole premises.

Effective

Good

Updated 10 June 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from National Institute for Health and Care Excellence and used it routinely. Patient’s needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Patients with multiple conditions and those over the age of 75 years were offered dedicated longer appointments. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 10 June 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for several aspects of care. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to understand. We also saw that staff treated patients with kindness and respect, and maintained confidentiality. We received 26 completed comment cards and they were all very positive about the service experienced. Patients were complimentary about all levels of staff within the practice stating they are polite and friendly, empathetic and caring.

Responsive

Good

Updated 10 June 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Feedback from patients indicated that there were no issues with access and booking appointments at the practice. They confirmed that they could see a doctor on the same day if they needed to The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 10 June 2015

The practice is rated as good for being well-led. It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity. There were systems in place to monitor and improve quality and identify risk. The practice sought feedback from patients and worked with the patient participation group (PPG) to make improvements to the practice. Staff had received inductions, regular performance reviews and attended staff meetings. Staff told us that the practice was very supportive of training and that they had local specialist speakers attend the practice to discuss areas for example where referral trends had increased.

Checks on specific services

Older people

Good

Updated 10 June 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Seventy-eight of the over 65 population had received a flu vaccination with 72% of eligible patients vaccinated against shingles.

People with long term conditions

Good

Updated 10 June 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice used a holistic recall programme for patients aged 75 years and over. This meant the patient was invited to one appointment for the all their chronic diseases resulting in one visit and one set of bloods taken.

Families, children and young people

Good

Updated 10 June 2015

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice arranged a Saturday morning child flu clinic for two to four year olds. The practice does not normally open on a Saturday but offered this service to encourage more children to be vaccinated.

Working age people (including those recently retired and students)

Good

Updated 10 June 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. Ring-fenced appointments were available for students of the local university. The practice’s extended opening hours was particularly useful to patients with work commitments. This was confirmed by a comment made by a patient stating they were happy that they could access the surgery as early as 7am.

People whose circumstances may make them vulnerable

Good

Updated 10 June 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. It had carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. The practice has developed their safeguarding policy to reflect the coding used by other agencies and shared this best practice with others in the locality.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice made prompt referrals to appropriate services with adult mental health as the practice’s highest referral category. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a good working relationship with an onsite counsellor. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.